About half of the population over age 50 in developed countries has diverticula which are outpouches or pockets in the colon. Such diverticular often become infected resulting in diverticulities.
Diverticulities is a disease in which the small pockets in the intestinal wall accumulate food reside materials which ferment, developing balloon-like pockets filled with gaseous material. The fermentation causes enlargement of the pockets, often resulting in discomfort. Sometimes the pockets rupture causing life-threatening peritonisis.
In the past, diverticulitis has been treated in various ways. The patient may be treated with drugs that minimize the fermentation reaction in the large intestine. This treatment results in some improvement, however, many pockets are closed off and thus the drugs do not readily enter the pockets. The patient may be placed on a diet which excludes food materials which are likely to cause the development of gaseous materials. For example, members of the cabbage and bean products may be eliminated from the diet.
Diagnoses of diverticulitis may be difficult. In some instances the patient is given a barium enema which coats the lining of the large intestine. X-rays are then taken and the diverticula are identified. In those instances where the pockets are closed off due to inflammation, the barium may not readily enter the pockets. In such instances, the large intestine may be injected with pressurized air which tends to enlarge the intestine, opening the pockets and permitting the barium to enter such pockets. The injection of air, of course, is a significant discomfort.
In other instances, diagnoses of diverticulitis is accomplished using a fiberoptic scope. The scope may be of the type illustrated by U.S. Pat. No. 3,643,653. Such devices include a viewing port which is connected to optic fibers running the length of a tube. The tube is inserted into the colon of the large intestine. The tube includes control mechanism that permits movement of the tube to a position adjacent the lining of the large intestine. The viewing device and the fiber optics are used to observe the lining and thereby identify the diverticula.
Upon observation of a significant diverticula problem, removal of a portion of the large intestine may be dictated. Such an operation has in the past required incision through the abdominal wall. A major surgery. Because of the seriousness of the operation, removal of diverticula sections in the past have been limited to only those cases where the diverticulitis is a very acute. Most persons having diverticular condition have in the past been required to suffer discomfort at various period throughout their life.
The present invention provides a device for removal of diverticula without incision. The present invention also provides a method for treating diverticular without incision through the abdominal wall.
Cl SUMMARY OF THE PRESENT INVENTION
The present invention provides a medical device, including an elongated tube, carrying a plurality of optical fibers together with a viewing device that permits observation through the optical fibers. The tube may also include a vacuum tube for vacuumizing the diverticula to invert such diverticula. Mechanism is included for securing the diverticula in the inverted condition, thereby resulting in the adjacent external wall of the diverticula fusing e.g., growing together. This securing mechanism may be a device for placing a rubber band or a plurality of rubber bands around the diverticula. Alternatively, the mechanism may include a stapling device which staples the inverted diverticula or mechanism for securing a noose around the inverted diverticula.
The device of the present invention may be somewhat similar in structure to the Pentax Flexible Fiber Optic Sigmoid Scope, Model 35, or similar devices made by Olympus with certain modifications or improvements. Such devices have been used in the past for observation within the colon. The present invention modifies and improves such previously existing scopes to permit not only observation, but also treatment of the diverticula.
The present invention consists of a flexible tubal extension to the suction oriface of the scope. The tubal extension may include a Teflon-coated or lubricated sleeve on which is mounted either stretched small rubber bands or pre-tied nylon or biodegradable nooses or surgical staples which can be manipulated by controls attached to the scope at a location outside of the body of the patient. During use, the tubal extension is guided to the entrance of the diverticulum in the colon using the fiber optic viewer which is embedded in the flexiscope. Once in place, the scope controls may be operated to create a vacuum in the tubal extension, thereby pulling the diverticula onto an inverted condition. Using the scope controls, the operator may then apply the vacuum to invert the diverticula extending such diverticula into the colon. The operator would then move the sleeve past the end of the tube, over the inverted diverticula to the colon wall. Using a special caliper, the operator may ease the rubber band, pre-tied noose or staple from the sleeve to around the base of the inwardly extending diverticula. If rubber bands are used, the stretched bands would retract, closing the end of the base of the diverticula. Over a period of several days, the tissue edges of the colon wall would grow together. The diverticula tissue would die and drop off to be excreted or removed through the lower end of the colon. If pre-tied nooses are used, the caliper would provided for slipping the noose off the sleeve. The noose would be attached to the caliper such that manipulation would draw the slip knot of the noose to close the diverticula. Again, the tissue would grow together and the diverticula would die and drop off. If surgical staples are used, a spring-loaded stapler would move a staple off the end of sleeve, closing the base of the diverticula.
The method of the present invention includes the steps of identifying enlarged problem diverticula, applying a vacuum to the diverticula in order to invert or turn such diverticula inside out. The method includes the further step of surrounding the base of the diverticula with a closure mechanism such as a rubber band or a staple. The exterior walls of the diverticula then grow together and the inverted diverticula dies and disintegrates.